Internet Use among Patients with Schizophrenia and Depression.

BACKGROUND: The high and increasing prevalence of internet use in the general population and the significant burden of depression and schizophrenia urge us to investigate the patterns of internet use among patients with these illnesses. The aim of this study is to assess internet use and mental health-related internet use among patients suffering from schizophrenia and depression. METHODS: A total of 104 patients with psychosis and 105 patients with depression were surveyed to assess their internet use and mental health-related internet use. RESULTS: The majority of participants were internet users (87.6%), with 66.7% of internet users with psychosis and 71.4% of internet users with depression using it as a source of information on mental health. Participants with psychosis significantly more attributed the internet and mental health internet forums as helpful in coping with their mental illness and were more interested in the utilization of online mental health services than participants with depression. CONCLUSIONS: General internet use in patients with schizophrenia and depression corresponds with the internet use of the general population; however, they use it more often as a source of health information than the general population. Mental health service providers should offer more online interventions and treatment programs to patients with psychosis and depression, as our study suggests there is an unmet need for online mental health services for such patients.

Preliminary Assessment of Pre-Electroconvulsive Therapy Evaluation Practices in European Countries: The Need for Guidelines.

OBJECTIVES: Pre-electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries. METHODS: The data were collected as a snowball sample approach using an online survey from September 2019 to April 2020. The final analysis included data from 18 clinics placed in 16 European countries. RESULTS: Regulations on the pre-ECT evaluation were found in 9 countries. All clinics reported doing complete blood count, serum electrolytes, and renal function analysis as a part of regular laboratory testing, alongside with a cardiovascular assessment. Ten clinics reported using psychiatric scales. Six clinics reported doing a cognitive assessment, of which all had regulations on the pre-ECT evaluation. Not one evaluation had the same sets of procedures and diagnostics. CONCLUSIONS: The differences in assessment approaches mirror high variability of the pre-ECT evaluation practice across Europe. Cognitive assessment and objectification of psychiatric symptoms should be a regular part of the pre-ECT evaluation because of the monitoring of the most common adverse effect and observing the clinical response to ECT. Standardization of the pre-ECT evaluation and ECT in general would remove criticisms and opposition to the treatment, make it based on the best of our knowledge, and provide a method respectful of patients' best interests and rights.

Alcohol, COVID-19 and the smell of relapse: a case report.

The global pandemic lockdown created a risk factor for increased alcohol consumption in people with alcohol use disorder and relapse for those who were previously abstinent, with evidence suggesting that pre-lockdown abstinence status is not protective against lockdown-related relapse. We report a unique case of a middle-aged male with alcohol use disorder who experienced alcohol cravings and a fear of relapse due to exposure to disinfectants. A 54-year-old public transportation company worker, previously treated for an alcohol use disorder three times, and abstinent since his last treatment in 2017, reported anxiety, irritability, and constant fear of relapse due to increased exposure to sanitizers during the pandemic. He explained that while the diluted disinfectant made him think of alcohol, the now ever-present undiluted disinfectant makes him constantly crave alcohol and it makes it harder for him to work. Although he started group therapy treatment and had several follow-up visits, his poor performance at work and the fear of relapse resulted in him requesting a position change to work in open spaces and avoid the smell of disinfectant, which helped him remain abstinent. Disinfectants are a part of the "new normal," and their increased use is likely to be continued in the years to come, even after the pandemic resolves. Introducing a new behavioral pattern, such as the daily use of disinfectants in the general population, should prompt us to explore all possible consequences regarding its propagation.

100 Years apart: Psychiatric admissions during Spanish flu and COVID-19 pandemic.

The last pandemic comparable to the current COVID-19 pandemic was the Spanish flu. Using the admission record books for the years 1917 and 1918 and electronic health records for the years 2019 and 2020, we extracted the relevant data and explored how they affected the numbers of emergency psychiatric admissions. The general trend in both pandemics was that they did not cause a rise in psychiatric admissions, findings which go along with reports around Europe. The causes for these similarities are complex but provide an interesting perspective as to why there is no concurrent rise in emergency psychiatric admissions.

'An Apple a Day'?: Psychiatrists, Psychologists and Psychotherapists Report Poor Literacy for Nutritional Medicine: International Survey Spanning 52 Countries.

Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of individuals with mental disorders was poorer compared to the general population (p < 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as 'very good.' Almost all (92.9%) stated they would like to expand their knowledge regarding 'Nutritional Psychiatry.' There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care.

Preventing Post Traumatic Stress Disorder in the general population induced by trauma during the COVID pandemic: A simple brief intervention based on cognitive science that could be delivered digitally.

Most of the recent studies indicated the prevalence of Post-Traumatic Stress Symptoms (PTSS) are increasing after the COVID pandemic around the world. Bo et al. reported PTSS prevalence of 96.2% among the COVID-19-infected people. The sociocultural and individual vulnerability and protective factors may influence onset and maintenance of the symptoms. However, there is significant lack in understanding the risk factors and preventive factors that influence the maintenance of Post-Traumatic Stress symptoms that defines Post-Traumatic Stress Disorder (PTSD). The digital technology gives us the unique opportunity to assess this risk, to monitor and track this evolution longitudinally. In this research project we aimed to design and develop a smartphone application for longitudinal data collection enabling to (1) predict and follow the evolution of PTSS toward PTSD, (2) assess the relative efficacy of several methods to prevent the evolution of PTSS right after exposure to trauma (1-24 h), (3) educate people about psychological effects that can occur during and after trauma, normalize acute distress and refer to professional help if a disorder is constituted. We hope that this research project will help to understand how to maximize the self help support during the acute phase (golden hours) after trauma to prevent the transition from PTSS to PTSD. A video abstract can be found on https://www.youtube.com/watch?v=RZJehj3J8go&feature=emb_title.

The longitudinal course of schizophrenia: testosterone and progression of the negative symptoms.

Background: The longitudinal course of schizophrenia shows a high level of heterogeneity with testosterone as a possible factor in the variety of clinical outcomes.Aim: Evaluation of the course of schizophrenia in male patients over an eight-year period and of the possible testosterone effects on changes in clinical features.Subjects and methods: The initial study population consisted of 120 male schizophrenic patients (aged 18-40) hospitalized in the University Psychiatric Hospital Vrapce in 2009. Patients were classified into nonaggressive (control, n = 60) and aggressive (n = 60) groups. In 2017, we reassessed 85 patients (67,5%) from the initial sample. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS) and compared with the total serum testosterone level taken at the inclusion in the study. The distribution of values for individual variables was determined using the Smirnov-Kolmogorov test; for all further analyses, the appropriate non-parametric test was used.Results: The control group showed a statistically significant negative correlation between testosterone and negative PANSS. The initial PANSS scores, compared to those at the follow-up, showed a statistically significant reduction in positive and general symptoms in all groups, with the greatest reduction in the control group.Conclusion: We found a reduction in positive and general symptoms of schizophrenia among all patients and no changes in negative symptoms. Inverse correlation between testosterone and negative symptoms was found only in the control group, but there was no testosterone influence on the progression of any PANSS subscales.

Multidisciplinary Approach to Complicated Pregnancy.

A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic. On the ninth day postadmission, however, her condition abruptly deteriorated and advanced to imminent eclampsia, accompanied by transient vision loss, altered mental status, and acute hypertensive crisis. After the patient underwent successful emergent delivery via caesarean section, a laboratory workup revealed hemolysis, elevated liver enzymes, and low platelet count, suggesting HELLP syndrome, a serious complication of eclampsia. This patient concurrently developed posterior reversible encephalopathy syndrome, which was confirmed by magnetic resonance imaging and acute respiratory distress syndrome (the latter presented with diffuse bilateral infiltrates on x-ray and developing pulmonary edema in the absence of cardiac etiology). Because of these life-threatening dynamics, the patient was transferred to the intensive care unit for further treatment. This case is a rare cascade of life-threatening complications that developed in a patient and required skillful multidisciplinary decision making and experienced management within an acute critical care setting. The final outcome of the treatment and intensive care was successful because both the patient and child survived and had no chronic or debilitating sequelae.

A global amnesia associated with the specific variant of posterior reversible encephalopathy syndrome (PRES) that developed due to severe preeclampsia and malignant hypertension.

A case is reported of a 26-year-old primiparous woman in the 32nd week of gestation who presented to the emergency department with the symptoms of a severe headache, nausea and vomiting. The patient was diagnosed with preeclampsia that later progressed to eclampsia. This state was characterized by a sudden onset of a headache and diplopia that advanced to cortical blindness and precipitated significant alterations in mental status, most notable being global amnesia that resolved within 48 h. A post-partum magnetic resonance imaging of the brain in FLAIR mode revealed multiple cortico-subcortical areas of hyperintense signals suggestive of edematous lesions that chiefly involved occipital and parietal lobes with additional atypical manifestations. Such radiologic findings suggested a posterior reversible encephalopathy syndrome variant with the global amnesia as an extraordinary constituent. This unique feature should be acknowledged when treating a preeclamptic or hypertensive patient that exhibits neurological symptomatology and vision disturbances.